Our Thinking

Weathering the Storm in an Age of Personalized Care

In the same week that hurricane Harvey struck land leading to unprecedented devastation, there was groundbreaking news in healthcare. The US Food and Drug Administration approved the first CAR T therapy for the treatment of some children and young adults with the most common form of childhood cancer. CAR T is a landmark cell based gene therapy and is not a traditional medicine. It is the patient’s own immune cells that have been reprogrammed through gene therapy to recognize, target and kill the cells from which certain cancers arise. The innovation is not only in the therapy itself, but extends to the way it is made, grown, shipped, distributed, stored, administered and personalized. Requiring specialized training, 32 centers are approved to administer this innovative treatment — likely including a leading cancer center in Houston, Texas, one of the areas affected by Harvey.

The new era of personalized medicines designed to treat very specific patient populations in designated centers of excellence has resulted in better understanding of disease, as well as treatments that have extended survival and improved quality of life. But this kind of precision adds complexity to the intricate dance patients, health care providers, hospitals and companies play in patient care. This first CAR T approval coinciding with hurricane Harvey reminds us how a natural disaster can disrupt the delicate ecosystem of personalized care.

Following hurricanes Katrina, Sandy and now Harvey, health risks in recovering communities have emerged including growth of mold in flooded buildings, the increase of mosquitos with Zika or West Nile Virus near stagnant pools of water, and the contamination of drinking water. However, we must also consider the long term effects a disaster can have on a patient undergoing personalized treatment, the study of new medicines in clinical trials and the recovery of a hospital designated for specialized care. How do the missed rounds of treatment affect individual patient outcome and the overall results of a clinical trial? What will be the overall cost — not only in dollars, but in lives and speed of innovation — if biological materials cannot be recovered, centers of excellence are shut down long-term or clinical trials must be revised to account for the disaster? These questions (which don’t even uncover the tip of the iceberg) showcase the depth at which we must think for crisis preparation and recovery as personalized care continues to evolve.

As we brace for hurricanes Irma and Jose in the upcoming days, we know too well that the storms will keep coming. There are no simple solutions, but as long as we are acknowledging the obstacles that could stand in the way of personalized care, we are better prepared to address them. Hospitals, organizations, and companies have crisis plans in place to minimize the impacts of disaster. Patients should work with their doctors to understand these plans and the effect it could have on their treatment. The National Cancer Institute offers tips and resources for emergency preparedness for cancer patients, which can be applied to patients across disease states. Similar to recovery and preparation efforts made across the board in response to natural disaster, we must implement and clearly communicate the solutions for patient care so we can minimize the impact a storm can have on personalized care.